Information about Medication for ADHD

For many people the idea of giving children medication, especially medication that might affect their brain, is very controversial. Many parents would much rather not consider giving their children medication, although alternatively, many parents are also pleased that there is a possibility of medication that might help their children. A lot of children and teenagers don’t like the idea of taking tablets or feeling that there’s anything wrong with them.

  • It can be helpful to think of other kinds of medical conditions where there may be similar issues about prescribing medication. For instance, if your child had epilepsy they would be carefully assessed and you and their doctors would make a decision about whether they needed and would benefit from antiepileptic medication to control the fits. Such medication is quite sedative and has other side-effects and most parents understandably would have worries about this. If the child is only having one or maybe two fits a year and they are not really interfering with their life, then they wouldn’t necessarily be treated with medication. However, if a child is having a lot of fits, then the decision is likely to be that it would be best for them to be on medication even if there were some side effects. The important thing is that the decision whether to use medication is based on how much the illness or disorder is interfering with the child’s life and development. While ADHD/ADD and epilepsy are two different conditions the issues about deciding whether to prescribe or not are similar.

  • Methylphenidate (Ritalin? Equasym, Medikinet, Concerta XL, Equasym XL, Medikinet XL)

    This is the medication usually prescribed for children with ADHD and is an amphetamine-based drug.

    Why give an amphetamine to a hyperactive child? Because small amounts Increase the amount of the chemical transmitter dopamine in the brain, helping with concentration and reducing impulsiveness.

    Dosage: Methylphenidate can be prescribed in an immediate release tablet form which works for about four hours and needs to be given two to four times daily. Longer acting forms (tablets or capsules) are available which last eight to 12 hours and may only need to be given once a day.

    Side effects: These can include appetite loss, difficulty getting to sleep,dizziness and a ‘rebound’ effect when the last dose has worn off and the child becomes more irritable and hyperactive. Methylphenidate can sometimes cause muscle twitches or depression. If significant problems do occur, they usually stop quickly if the medication is stopped.

    Dexamfetamine (Dexedrine)

    This is a stimulant medication very similar to methylphenidate and works in a similar way by increasing the amount of the chemical dopamine in the brain.

    Dosage: Medication is given in a tablet form and acts in a similar way to methylphenidate in that it takes about 30 to 40 minutes to work and wears off after about four hours.

    Side effects: Like methylphenidate the most common side effects are on sleep and appetite. When prescribed: Dexamfetamine is most commonly used if treatment is needed for a child under six years old, or if a trial of methylphenidate hasn’t worked.

    Atomoxetine (Strattera)

    This is a relatively new medication to treat ADHD called a ‘selective noradrenaline re-uptake inhibitor’. It is a non-stimulant medication that can be used to treat children (six years old and above) and adults with ADHD.

    How does it work?: It works in the brain and increases the levels of a chemical called noradrenaline which helps in passing messages between brain cells. Noradrenaline is considered important in controlling attention,impulsiveness and activity levels. Strattera has been shown to help control the symptoms of ADHD.

    Dosage: Atomoxetine capsules are given one to two times a day and give an effect lasting 24 hours. Atomoxetine can take several weeks to have its full effect.

    Side effects: These can include decreased appetite, being sick and stomach pains.

    The National Institute for Health and Clinical Excellence published guidance on the treatment of ADHD in September 2008. It recommend that methylphenidate should be the first choice drug for most children aged six and older. The choice of which drug depends on the individual circumstances of each child or young person, and the decision is made following consultation with the child/young person and their carers.

  • The following medications are not the first choice of use, but might be prescribed on their own or along with another drug if a child or young person has not responded to one of the medications above, or had problems with side effects.

    Risperidone (Risperdal)

    This is an ‘antipsychotic medication’ primarily prescribed to adults who have psychotic episodes. It is not licensed for use with children in the UK.

    Why is it prescribed to ADHD children? Risperidone might be prescribed I a child was exceptionally aggressive, had not responded well to a first choice medication or had troublesome side effects (for example, loss of appetite).

    Dosage: Risperidone is given once or twice daily in small doses (usually less than 2mg daily). It can take several weeks before any improvements are seen in a child.

    Side effects: These can include weight gain, dizziness, sleep problems, constipation and tiredness.

  • Imipramine (Tofranil), Clonidine (Catapres), Aripiprazole (Abilify) and some other drugs are sometimes used, but only when other medications have not worked well. This is because they are either not as effective, or have more side effects than the usual drugs.

(This information has been put together with the help of Dr S Macaulay, Consultant in Child and Adolescent Psychiatry, Northumbria Health Care Trust.)